Mechanical damage to eyes
appendages damage may result from eye injury or contusions.In the first case could be damaged eyelids with a through or non-through tissue integrity violation century breaks mucosal lesions of the lacrimal gland and lacrimal tract.In such cases, the patient should be laying antibacterial ointment and a bandage aseptic urgently sent to the eye department, where it will be made debridement.
1. In blunt trauma age possible bleeding in the thickness of the eyelids or subcutaneous emphysema, which indicates the violation of the integrity of the bones of the orbit, bordering the air sinuses.Blunt injuries occur from a blow to the eye with a stick, fist, workpiece, animal horn, etc.This gives rise to various symptoms, and combinations thereof (depending on the severity of injury):
• hemorrhage eyelids, under the conjunctiva, the anterior chamber, vitreous body, retina;
• breaks iris, choroid, retina, optic nerve;
• lens injury - its offset in the anterior chamber, under the conjunctiva, into the vitreous o
blunt trauma often accompanied by secondary glaucoma.Perhaps crushing eyes.
treatment.Patients urgently sent to the optometrist a binocular bandage in the supine position.In a hospital, depending on the evidence produced surgery (removal of dislocated or cloudy lens suturing to the sclera, the eye and the removal of crushing al.).
2. When wound and contusion can damage the bones of the orbit, the displacement of their fragments, which would entail a reduction or increase in the volume of the orbit, and in this regard - a protrusion or retraction of the eyeball.When these injuries as a result of rupture of the optic nerve, injury of the eyeball with extensive hemorrhages, fractures of the inner shells and even crush the eye can occur suddenly, often irreversible blindness.orbit Injuries are always very serious, as they can be complicated by infection: phlegmon of the orbit, cavernous sinus thrombosis, meningitis, constitutes a threat to vision and life of the patient.Injuries orbit due to injury may be complicated by the introduction of foreign objects (metal fragments, wood, bullets, etc.).Wounds of the conjunctiva and lacrimal organs undergo surgical treatment, whose main goal is to restore function.
damage the eyeball is divided into neprobodnye, perforated, obtuse, or contusions and burns.
Neprobodnye superficial injuries are applied in small foreign bodies (sand grains emery stone, metal, wood, etc.), Getting stuck in the groove of the upper eyelid cartilage or incorporated into the surface layers of the cornea.At the same time there was a sharp pain in the eye, photophobia, lacrimation.Speck, trapped in the conjunctiva, it is necessary to remove a piece of damp wool, removing the upper eyelid.
The foreign body of the cornea is removed by special sterile instruments (chisel or spear) after anesthesia dikainom or lidocaine.To remove the foreign body is also used a disposable syringe needle.For this patient forever pushing the index finger and thumb of the left hand and right hand tool is supplied by a foreign body so as to remove it together with the remainder of rust, then lay the ointment of the antibiotic.In some cases, the obvious signs of the iris irritation need to expand the pupil (better scopolamine) and keep it in this state to reduce inflammation (2-4 days).At that time and up to narrowing of the patient's pupil should be exempt from the work, since the expanded pupil reduced visual acuity, binocular vision is absent, resulting in a danger of damage to healthy eyes.In cases of deep introduction of a foreign body, and in complications (corneal ulcer, iritis) arising after the removal of a foreign body, the patient should be imposed on the eye aseptic dressing and cooking surgery.
Superficial injuries without the introduction of a foreign body may be applied to a branch, straw, snow, finger;they are usually accompanied by a defect of the corneal epithelium - erosion detectable relief after instillation Fluorescent.Treatment is carried out similarly as after the removal of foreign bodies, and in addition, restore the integrity of the corneal epithelium promotes blood antibiotic use.To do this, from a vein of the patient take a 5 ml syringe and a few drops of blood irrigate her eyes;remaining blood was poured into the bottle with the same amount of antibiotic solution and recommended 4-5 times a day, the mixture was instilled into the eye together with the separated serum with antibiotics.It should be remembered that the patient should be examined by a rapid method to lues (syphilis).
Penetrating wounds are applied cutting and piercing items, firearms, bird beak, the explosions, the introduction of metal or other foreign bodies in the eyes, etc.The severity of damage depends on the size and shape of wounding instruments, foreign body, its place of introduction into the eye (cornea, sclera, or a limb), the presence of infection, etc. One of the main symptoms of penetrating injury -. Decrease in intraocular pressure (hypotension), caused by the expiry of chamber moisture orvitreous, gaping wounds, the infringement in its margins dropped shells.Frequent bleeding under the conjunctiva, the anterior chamber (hyphema) or vitreous (hemophthalmus), lens damage.Penetrating wounds lead to a decrease in visual acuity varying degrees.Particularly serious injury to the introduction of foreign bodies in the eye.Patients with penetrating eye injuries, regardless of medical history is required to produce X-rays of the skull and orbit for the diagnosis and localization of foreign bodies.Suspected presence of a foreign body occurs when the iris is detected gap with the hole in it.In some cases, it manages visible foreign body in the anterior chamber, or the vitreous of the eye.Intraocular foreign body due to mechanical damage of the eye membranes and chemical effects, metal (metallosis) is a direct indication for its urgent removal under eye hospital.At long stay of iron or copper splinter in the eye tissue in his metal deposition occurs.This iris becomes rusty color, and the front lens capsule deposited rust spots or cataract occurs.Injuries may be complicated by infection, signs of which are swelling of the eyelids and conjunctiva of the eyeball, pus in the anterior chamber or Panophthalmitis.
The most serious complication of penetrating injury is an inflammation of a second, undamaged eye in the form of sluggish serous or fibrinous iridocyclitis or optic neuritis, sympathetic called inflammation.It can occur after the operation with the opening of the eyeball, and sometimes after the diseases associated with violation of the integrity of the eye (eg, cornea ulcer perforation).Sympathetic inflammation develops, as a rule, in cases where a penetrating wound complicated sluggish, iridocyclitis not amenable to treatment.
Sympathetic inflammation begins 10-14 days after the injury, but may occur later, months and years afterwards.The cause of the disease is still unknown, it is assumed the value of a viral infection, a specific allergy.No signs and accurate, helping to establish the possibility of its occurrence in each case, we only know that if the wounded blind eye for a long time does not calm down because of the persistent sluggish iridocyclitis, disease, then the risk of sympathetic inflammation in the other eye increases.Therefore, such a blind eye must be removed for the prevention of sympathetic inflammation.If damaged partly retained eye sight, should continue to be treated and depending on the success and especially the state of the healthy eye to solve the problem of removing damaged.Signs of sympathetic inflammation: sudden decrease in visual acuity of healthy eyes, tearing, photophobia, conjunctival injection deep eyes expressed iridocyclitis with its consequences.The process may begin optic neuritis, occasionally and without vascular tract inflammation.The disease is characterized by extreme weight and about half of the patients end blindness, despite treatment.In the best case, if the eye recovers and preserves eyesight, inevitable recurrence of inflammation, which is the outcome is always serious.
patient with a penetrating eye injury need an antibiotic drip solution binocular impose aseptic bandage, tetanus toxoid, and enter immediately to prepare for surgery.Of great importance for the outcome of penetrating wounds are the primary treatment of wounds and giving the correct position of the edges of the wound with the help of silk sutures or biological;seasoned or excision of the separated shells, removing the lens cloudy and others. In the case of a magnetic eye after intraocular foreign body accurately determine the localization of its permanent magnet is removed manually or larger electromagnet.Much more difficult and less successful in removing the magnetic foreign bodies from the eye.
treatment. Applied atropine, pilocarpine or by prescription, topically administered antibiotics or disinfectants, and after 7-10 days after wound treatment - instillation or subconjunctival injections of corticosteroids.Pursue a course of intramuscular injections or antibiotics into the introduction of tissue preparations, blood transfusions, X-ray and ultrasound therapy, and others. The same treatment is carried out at the sympathetic nerve, at the same time in each case individually to decide whether to remove the damaged eye.Exodus penetrating trauma depends on the nature, size and location of injury, the presence of infection, timeliness and quality of first aid and subsequent treatment.